David R. Garr

Clinical prevention and population health: Curriculum framework for health professions

Abstract The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services–health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title “Clinical Prevention and Population Health” has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.

Evidence-based health promotion programs for schools and communities.

Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education to prevent health problems in the following areas: unintentional injury; violence; suicide; tobacco use and addiction; alcohol or other drug use; unintended pregnancy, HIV/AIDS, and sexually transmitted infections (STI); unhealthy dietary patterns; and inadequate physical activity. These specific goals are part of the efforts of Healthy People 2020 to increase the proportion of elementary, middle, and senior high schools that have health education goals or objectives that address the knowledge and skills articulated in the National Health Education Standards. A focus on Pre-K through 12 health education is a prerequisite for the implementation of a coordinated, seamless approach to health education as advocated by the Healthy People Curriculum Task Force and incorporated into the Education for Health framework. To help accomplish these goals, this article views the role of education as part of the broader socioecologic model of health. A comprehensive literature review was undertaken to identify evidence-based, peer-reviewed programs, strategies, and resources. The results of this review are presented organized as sexual health, mental and emotional health, injury prevention, tobacco and substance abuse, and exercise and healthy eating. Evidence-based implementation strategies, often considered the missing link, are recommended to help achieve the Healthy People 2020 objective of increasing the prevalence of comprehensive school health education programs designed to reduce health risks for children.

Prevention Education and Evaluation in U.S. Medical Schools: A Status Report.

The Prevention Curriculum Assistance Program (PCAP) was initiated to help U.S. medical schools examine the extent to which they are evaluating the learning of medical students about disease prevention/health promotion. A survey was sent to all 144 allopathic and osteopathic medical schools, with an overall response rate of 68%. The results revealed more emphasis on teaching and evaluating the learning of medical students in the areas of clinical preventive services and quantitative methods, and less emphasis on the community dimensions of medical practice and health services organization and delivery. Written tests and unstructured observation are the most common methods of evaluation. Fewer than half of all respondents were satisfied with the quality of their assessment of student achievement in any of the four domains of prevention education. More than 30% expressed a desire to receive assistance with designing curricula and/or evaluation methods in each of the four content areas examined. Several indicated their willingness to assist colleagues who want to improve their prevention curricula and/or measurement strategies. This study identified a need for more attention and support for prevention education and evaluation programs. Curriculum leaders can help by designating prevention a priority area and appointing faculty to be responsible for monitoring the content and quality of prevention teaching throughout the curriculum. Resources such as the Internet can be utilized to establish a network whereby medical schools can collaborate to improve their educational programs and evaluation methods in prevention.

Differences in Readiness Between Rural Hospitals and Primary Care Providers for Telemedicine Adoption and Implementation: Findings From a Statewide Telemedicine Survey

PURPOSE Published advantages of and challenges with telemedicine led us to examine the scope of telemedicine adoption, implementation readiness, and barriers in a southern state where adoption has been historically low. We hypothesized that rural hospitals and primary care providers (RPCPs) differ on adoption, readiness, and implementation barriers. We examined the degree to which they differ on (a) telemedicine adoption or readiness; (b) telemedicine training needs; (c) current use of technology for patient care; and (d) environmental concerns in facilities for telemedicine. METHODS Paper surveys were sent to rural hospitals and RPCPs with response rates of 50% (n = 38) and 25.9% (n = 339), respectively. Three of 4 hospitals were represented. Chi-square analyses were used to test for differences between rural hospitals and RPCPs. FINDINGS Compared to RPCPs, rural hospitals were significantly more likely to report higher rates of telemedicine knowledge (P= .0007); planning for or implementing telemedicine (P < .0001); and reporting their disaster recovery data systems (P= .0002) and availability and location of outlets and connections (P= .03) as adequate for telemedicine. Rural hospitals were less likely to report having no telemedicine education needs (P= .04). CONCLUSIONS Telemedicine continues to be a viable solution for bridging geographic access gaps to a variety of specialty care. Users need assistance in understanding legal implications, care coordination, billing for services, and disaster data recovery. In rural areas, hospitals appear to best embody characteristics of facilities that successfully implement telemedicine and have the greatest degree of readiness.

The status of interprofessional education and interprofessional prevention education in academic health centers: a national baseline study.

Purpose Given the emphasis on prevention in U.S. health care reform efforts, the importance of interprofessional education (IPE) that prepares health professions students to be part of effective health care teams is greater than ever. This study examined the prevalence and nature of IPE and interprofessional (IP) prevention education in U.S. academic health centers. Method The authors extracted a 10-item survey from the longer published IPE Assessment and Planning Instrument. In September 2010, they sent the survey to 346 health professions leaders in health sciences schools and colleges at 100 academic health centers. These institutions were identified via the online membership list of the Association of Academic Health Centers. The authors conducted descriptive statistical analysis and cross-tabulations. Results Surveys were completed by 127 contacts at 68 universities in 31 states and the District of Columbia. IPE was more prevalent than IP prevention education in all categories of measurement. Respondents affirmed existence of IPE in courses (85.0%) and in clinical rotations/internships (80.3%). The majority reported personnel with responsibility for IPE (68.5%) or prevention education (59.8%) at their institutional unit, and 59.8% reported an IPE office or center. Conclusions This study provides evidence that IPE and IP prevention education exist in academic health centers, but additional attention should be paid to the development of IP prevention education. Sample syllabi, job descriptions, and policies may be available to support adoption of IPE and IP prevention education. Further effort is needed to increase the integration of IP and prevention education into practice.

Evidence-based public health education as preparation for medical school.

The Institute of Medicine has recommended that all undergraduates have access to public health education. An evidence-based public health framework including curricula such as “Public Health 101” and “Epidemiology 101” was recommended for all colleges and universities by arts and sciences, public health, and clinical health professions educators as part of the Consensus Conference on Undergraduate Public Health Education. These courses should foster critical thinking whereby students learn to broadly frame options, critically analyze data, and understand the uncertainties that remain. College-level competencies or learning outcomes in research literature reading, determinants of health, basic understanding of health care systems, and the synergies between health care and public health can provide preparation for medical education. Formally tested competencies could substitute for a growing list of prerequisite courses. Grounded in principles similar to those of evidence-based medicine, evidence-based public health includes problem description, causation, evidence-based recommendations for intervention, and implementation considering key issues of when, who, and how to intervene. Curriculum frameworks for structuring “Public Health 101” and “Epidemiology 101” are provided by the Consensus Conference that lay the foundation for teaching evidence-based public health as well as evidence-based medicine. Medical school preparation based on this foundation should enable the Clinical Prevention and Population Health Curriculum Framework, including the evidence base for practice and health systems and health policy, to be fully integrated into the four years of medical school. A faculty development program, curriculum guide, interest group, and clear student interest are facilitating rapid acceptance of the need for these curricula.

Healthy People 2020 and Education for Health: What Are the Objectives?

The Education for Health framework is designed as an educational roadmap for Healthy People 2020. It aims to connect the educational phases and suggests overall educational strategies needed to educate health professionals and the public to achieve a healthier America. The framework seeks to develop a seamless approach to prevention and population health education from Pre-K through graduate school. The framework is built on national movements in health literacy, undergraduate public health education and evidence-based thinking. It envisions a coordinated set of learning objectives divided into Pre-K through Grade 12, 2-year and 4-year colleges, and graduate education in the health professions as well as for health education for the community-at-large. The Healthy People Curriculum Task Force, a consortium of eight health professions education associations, has developed the framework and connected the framework with new and revised educational objectives of Healthy People 2020. The Task Force envisions a decade-long process to define and implement specific learning outcomes that can be integrated across the educational continuum. Interprofessional prevention education, in which health professionals learn and practice together, is seen by the Task Force as a key method for implementation. Understanding the roles played by a range of clinical health professions is also essential to communication and understanding. Healthy People 2020 and its new and revised educational objectives provide a vehicle for promoting the discussion and experimentation that will be needed to achieve an integrated and seamless approach to education for health for the American public as well as for health professionals.

Oral Cancer Prevention and Early Detection: Using the PRECEDE-PROCEED Framework to Guide the Training of Health Professional Students

Abstract Background. Teaching cancer prevention and detection is important in health professional education. It is desirable to select a comprehensive framework for teaching oral cancer (OC) prevention and detection skills. Methods. The PRECEDE-PROCEED model was used to design a randomized pretest and posttest study of the OC prevention and detection skills of dental students (n = 104). OC knowledge, opinions, and competencies were evaluated. Results. Second year students in the intervention group were more competent than those in the control group. Conclusions. The novel use of PRECEDE-PROCEED sets a precedent for designing a standardized OC curriculum for a wide range of health professional disciplines. J Cancer Educ. 2007;22:250–253.

South Carolina Area Health Education Consortium Disaster Preparedness and Response Training Network: an emerging partner in preparedness training

The South Carolina Area Health Education Consortium (SC AHEC) was funded in 2003 to train healthcare professionals in disaster preparedness and response. During the 5 years of funding, its Disaster Preparedness and Response Training Network evolved from disaster awareness training to competency-based instruction and performance assessment. With funding from the assistant secretary for preparedness and response (ASPR), a project with implications for national dissemination was developed to evaluate 2 aspects of preparedness training for community-based healthcare professionals. The SC AHEC designed disaster preparedness curricula and lesson plans, using a consensus-building technique, and then (1) distributed sample curricula and resources through the national Area Health Education Center system to assess an approach for providing preparedness training and (2) delivered a standardized preparedness curriculum to key influential thought leaders from 4 states to evaluate the effectiveness and acceptability of the curriculum. As a result of this project, the SC AHEC recommends that preparedness training for community-based practitioners needs to be concise and professionally relevant. It should be integrated into existing healthcare professions education programs and continuing education offerings. The project also demonstrated that although AHECs may be interested and well suited to incorporate preparedness training as part of their mission, more work needs to be done if they are to assume a prominent role in disaster preparedness training.

Achieving the Triple Aim: A Curriculum Framework for Health Professions Education

The 2014 Clinical Prevention and Population Health Curriculum Framework in this issue of the American Journal of Preventive Medicine is described as a resource for preparing health professionals to achieve the Triple Aim: improving the patient experience of care, reducing the per capita cost of care, and improving the health of the population. The strengths of the Framework in guiding health professions education are described and the consensus-based process that included members from major health professional organizations to develop the Framework is discussed. Links are provided to examples illustrating the Framework’s use in health professions educational settings.